VI. Imithelela yokunciphisa izinga lokushisa komzimba ngokusebenza
(I) Imithelela ohlelweni lwenhliziyo nemithambo yegazi
(II)Imiphumela ku-coagulation
Ukusebenza kweplatelet ebuthakathaka kunciphisa umsebenzi we-clotting factor, okuholela ekuphumeni kwesikhathi eside futhi kwandise inani lokopha. Izinga lokushisa eliphansi libuye liholele ekumileni kwegazi ekumeni kwegazi emithanjeni, okungadala kalula i-deep vein thrombosis.
Izinga lokushisa lomzimba lingaphansi kuka-35°C, lezi zinkomba ezilandelayo zelulwa ngokuphawulekayo nezinga lokushisa Lezi zinkomba ezilandelayo zelulwa ngokuphawulekayo nezinga lokushisa elinciphayo:
Isikhathi se-prothrombin esicushwe ngokwengxenye (APTT)
Isikhathi se-Prothrombin (PT)
Isikhathi se-Prothrombin (TT)
(III) Ukwanda kwezifo zokusikwa
Ukushisa okuphansi komzimba kungaphazamisa ngokuqondile ukusebenza kokuzivikela komzimba, ukunciphisa ukunikezwa kwegazi komoyampilo esikhumbeni, kanye nokuhlanganiswa kwamaprotheni kanye ne-glial; ngesikhathi esifanayo, ukungagcwali kahle kwezicubu ze-peri-incisional kanye nokulibaziseka ukuphulukiswa kokusikwa kuholela ekukhuleni kwezinga Lezinga lokutheleleka kwenxeba liyakhula.
Amazinga okushisa angaphansi kokuhlinzwa angaphansi kuka-35°C ahlotshaniswa nokwanda okuphindwe kathathu kokutheleleka kwenxeba kanye nokuhlala esibhedlela isikhathi eside ngo-20%.
Kuthathwe ku:Zhang Y. Ukunakekelwa kwe-perioperative hypothermia[J]. Xinjiang umuthi wamaShayina,2011.29(04).92-94.Operating room nursing 512
(IV)Ukuvuswa ukubambezeleka
-Ukuncipha kokugeleza kwegazi kwe-visceral ku-hypothermia
-Ukuncipha kokusebenza kwesibindi
-Ukunciphisa ukugeleza kwegazi kwezinso kanye nezinga lokuhlunga kwe-glomerular
-Slower izidakamizwa umzimba
I-Hypothermia ivimbela ukusebenza kwezinzwa ezizwelayo futhi inciphisa ukukhiqizwa kwe-catecholamine, okwenza buthaka ukuphendula komzimba ekushukunyisweni kwangaphandle, kuyilapho izibulala-zinzwa zigaywa emzimbeni ngenani eliphansi, okuholela esikhathini esithe xaxa sokuphaphama kanye nokuphuma.
(V) Ukuphazamiseka kwe-metabolic
Ithinta imetabolism yomzimba
-Izinzwa ezihamba kancane
I-Acidosis, ukungalingani kwe-electrolyte
-Ukungasebenzi kahle kwamasosha omzimba
-Ukwandisa ukusetshenziswa kwe-oxygen emzimbeni
-Izinguquko endaweni yangaphakathi
I-Hypothermia yehlisa izinga lokugayeka kokudla emzimbeni, futhi kulo lonke izinga lokushisa lomzimba eliphansi ngo-1C, izinga lokugayeka kokudla liyancipha ngo-6%. Emazingeni okushisa omzimba angama-28C, izinga le-metabolic lingama-50% elijwayelekile.
Kuthathwe kokuthi:Yu Dingning,Li Duo,Ingozi ye-hypothermia nokwelashwa kwayo[J]. Imithi Yaphesheya: Ukuhlinzwa Kwemithi Yangaphandle:Ukuhlinzwa,2004,31(5):258-261.
VII.Izindlela zokuthola izinga lokushisa lomzimba ngesikhathi sokuhlinzwa
Eqinisweni, umehluko phakathi kwamazinga okushisa angaphakathi kanye nangaphezulu komzimba kunzima ukuwulinganisela ngaphandle kobudlelwano bomugqa, ngakho-ke kunconywa ukusebenzisa i-monitor probe yomzimba ukuze kutholwe ngokunembile izinga lokushisa lomzimba uma izimo zivuma.
VIII.Ukuvimbela i-perioperative hypothermia nokunakekelwa
(I)Ukungenelela kokunakekelwa ngokwengqondo
Ukuvakasha kwangaphambi kokusebenza (ukuhlola):
Ngokuvakashela ngaphambi kokuhlinzwa, isimo sesiguli sihlolwa ngokwanele, kuhlonzwe ubuhlengikazi, kuhlongozwe uhlelo lokuhlengikaza, ukwenza amalungiselelo okwanele, futhi kusetshenziswe izinyathelo zokufudumala ngosuku lokuhlinzwa ukuze
ukuvimbela i-hypothermia.
Ngesikhathi esifanayo, ngokuvakasha kwangaphambi kokuhlinzwa, ukwandisa ukujwayela komhlengikazi nesiguli, okulungele ukuxhumana okungcono phakathi kwabahlengikazi neziguli. ukuqashelwa, okusiza ekukhulumisaneni okungcono phakathi kweziguli nabahlengikazi futhi kunciphisa uvalo lweziguli. ukwethuka kweziguli kanye nokwehlisa imingcele yazo ukuze bathole amakhaza. Umkhawulo wesiguli wokuvuselela amakhaza uzokwehliswa.
(II)Izinga lokushisa kwemvelo
Izinga lokushisa elilawulwa ngamandla lika-21-25 ° C. Ukugcina umswakama ku-30-60%
Ukugcina izinga lokushisa elifanele kanye nomswakama kunganciphisa ukulahlekelwa ukushisa esikhumbeni futhi kuyindlela ephumelelayo yokuvimbela i-hypothermia.
Izinga lokushisa kanye nomswakama wekamelo lokuhlinza lilawulwa yi-air conditioner ephakathi, izinga lokushisa lekamelo lizolungiswa libe ngu-25 ° C ngaphambi kokuqala kokusebenza kwesiguli, futhi ngemva kokuqala kokusebenza kuzolungiswa ku-21-23 ° C. Kuqinisekisiwe ukuthi isiguli ngeke sithinteke imvelo ethinta ukuguqulwa kwezinga lokushisa lomzimba.
(III) Ukufudumala kwamanzi
A. Uketshezi olufakiwe lufudumale lwafika ku-37°C:
Usawoti womzimba noma amanzi omjovo asetshenziselwa ukubulala amagciwane esikhumbeni kanye nokugeza afakwa ku-thermostat futhi alungiselwe ku-37°C. Yikhiphe ku-thermostat ngaphambi kokuyisebenzisa ukuze unciphise ukulahlekelwa ukushisa komzimba.
B. Ukusetshenziswa kwe-infusion efudumele ngesikhathi sokumpontshelwa igazi:
Lapho kufakwa igazi eliningi, umshini wokufudumeza igazi uzosetshenziswa ukuze kuqinisekiswe ukuthi uketshezi olujovelwe emzimbeni wesiguli luseduze nezinga lokushisa lomzimba wesiguli.
(IV) Sebenzisa okokusebenza kwe-insulation
Ingubo ethambile ephefumulayo isetshenziselwa ukumboza indawo engahlinzeki, kusetshenziswa izinga lokushisa elithile endaweni yokushisa yomzimba yegesi ephezulu yokuguquguquka isetshenziswa ebusweni bomzimba ukukhulisa izinga lokushisa lomzimba wesiguli, kwehlise ukushisa kwangaphakathi endaweni ephansi yokushisa, futhi idlale indima yokuhlukanisa umzimba nendawo ebandayo ezungezile, ukushisa okusebenzayo kwesikhumba esishisayo.
(V)Isikhathi esincishisiwe sokuchayeka sokubekwa koshintsho lwesikhundla
A.Thuthukisa inqubo yokubeka indawo esezingeni ukuze unciphise isikhathi sokuchayeka sokushintsha isikhundla
B.Isikhundla Sezikhundla Ezikhethekile Zokuhlinza
I-Orthopedics: indawo ethambekele
I-Thoracic: indawo elele eceleni
I-Urology: Isikhundla sokulala eceleni
I-Lithotomy → indawo ethambekele: i-percutaneous nephrolithotomy (PCNL), njll.
(VI)Ukuvikela amanzi
Gwema noma unciphise ukucwiliswa kwamashidi.
Mboza ishidi eliyinyumba ngongqimba lwesikhwama sepulasitiki (inqobo nje uma lingangcolisi futhi lithinte indawo yokuhlinza).
Vimbela ukucwiliswa kwesiguli nelineni lombhede ngenani elikhulu lama-rinses ngesikhathi sokuhlinzwa.
Ngokuhlinzwa okudinga amanzi amaningi anephunga elimnandi, njengokuhlinzwa komchamo (i-prostate electrocision, percutaneous nephrolithotomy, njll.), Ukuhlinzwa okuvulekile (ukwelashwa okuvulekile okuqinile komdlavuza wamathumbu, ukukhishwa kwesibindi, njll.), ukuhlinzwa komdlavuza wabesifazane, njll.
Isifinyezo:
Isenzo se-intraoperative hypothermia siye sakhanga kancane kancane ukunakwa kwabasebenzi bemitholampilo ngokusebenzisa indawo elawulayo yomzimba kanye nokukhishwa kokushisa komzimba ngaphambi nangesikhathi sokuhlinzwa, futhi ukwamukela izinhlobonhlobo zezinyathelo zobuhlengikazi ukudala indawo ekhululekile yangaphakathi nangaphandle yomzimba kungavimbela ngokuphumelelayo i-hypothermia ye-intraoperative ezigulini. Kuncishisiwe Kunganciphisa izinkinga eziningi ezibangelwa i-hypothermia, kunciphise ubuhlungu beziguli, kufinyeze usuku lokulaliswa esibhedlela, futhi kunciphise izindleko zezokwelapha zeziguli, okulungele ukululama kusenesikhathi.
Isixhumanisi sesihloko esidlule: https://www.mecanmedical.com/Prevention-and-Care-of-Intraoperative-Hypothermia-Part-1-id61252817.html
